台灣護理人員住院風險及其相關因素

研究背景及目的: 護理工作面臨工作時間過長、高壓力的工作環境、職場上潛在有害物質，再加上輪班制度，致使護理人員長期執業於高風險之工作環境；本研究目的為比較護理人員與一般族群之住院風險。研究方法: 本研究採回溯性描述性研究設計，以2011年至2013年全民健康保險學術研究資料庫「醫事人員基本資料檔(PER)」、「醫事機構基本資料檔(HOSB)」及「住院醫療費用清單明細檔(DD)」進行串檔分析。應用住院標準化發生率(SHR)模型分析護理人員與一般族群各疾病之住院相對風險。結果: 在研究期間，控制護理人員性別、年代與年齡後，計算標準化住院率後，得知女性護理人員在「感染與寄生蟲疾病(SHR=121.05，95%CI=112.66-129.89)」、「呼吸系統疾病(SHR=105.12，95%CI=100.60-109.80)」、「妊娠、生產及產褥期之併發症(SHR=102.59，95%CI=100.85-104.35)」、「皮膚與皮下組織疾病(SHR=109.71，95%CI=101.10-118.86)」等，比一般族群住院風險顯著高。結論與建議: 女性護理人員在感染寄生蟲疾病、呼吸系統疾病、「妊娠、生產及產褥期之併發症」及「皮膚與皮下組織疾病」相較一般族群有高住院風險，因此建議：(1)在感染疾病方面：感控在職教育之落實及提供臨床護理人員完善之防護設備與正確使用口罩方法等；（2）在呼吸系統方面：鼓勵第一線人員，能接種流行感冒疫苗；(3)在生產及產褥期之併發症方面：建議護理部門能成立懷孕替代人力之制度、避免懷孕者於高風險單位執業及成立懷孕員工關懷管道機制等。

關鍵字

護理人員；住院風險；健保資料庫

並列摘要

Research Background and purpose: Nurses have long been working in the high-risk environment resulted from several factors, such as long working hours, intensive stress, potential toxic substance existing in the workplace and shift system. The purpose of this study was to compare the hospitalization risk between nurses and other occupations. Research Methods: A retrospective and descriptive study design was conducted in the study. The standardized hospitalization ratio (SHR) was applied to analyze the data archived in the Taiwan National Health Insurance datasets, including 「Registry for Medical Personnel (PER) 」, 「Registry for Contracted Medical Facilities (HOSB)」and 「Inpatient Expenditures by Admissions (DD)」from 2011 to 2013. Results: Using gender, calendar year and age as controlled variables to calculate standard hospitalization rate, the result of the study suggested that female nurses’ “infection and parasites (SHR=121.05, 95%CI=112.66-129.89）”, “respiratory disease (SHR=105.12, 95%CI=100.60-109.80)”, “pregnancy, childbirth and puerperium complications (SHR=102.59, 95%CI=100.85-104.35)”, and “skin and subcutaneous tissue diseases (SHR= 109.71, 95%CI=101.10-118.86)”, were significantly higher than those of other occupations during the target research years (2011-2013). Conclusion/Suggestion: Female nurses had significantly higher “infection and parasites”, “respiratory disease”, “pregnancy, childbirth and puerperium complications”, and “skin and subcutaneous tissue diseases” than other occupations. Therefore, various actions are needed to be taken for prevention and protection. (1) For infectious diseases: the implementation of in-service education about infection control and the providence of comprehensive protection equipment and correct education about how to use mask are necessary. . (2) For respiratory systems, the frontline nurses should be encouraged to take vaccination for flu. (3) For pregnancy, childbirth and puerperium complications, it is suggested that nursing departments establish alternative manpower systems to avoid the situations of pregnant nurses’ working in high-risk wards. Proper caring systems should be established, too.